Sunday, August 7, 2016

Excessive Flexion/ Inadequate Extension

Excessive Flexion/ Inadequate Extension



  1. Stance Phase
    1. Primary causes- hams spasticity / contracture as in cp
-quads weakness in polio
    1. Secondary cause – inc DF as a result of ankle PF weakness –after lengthening of
heel cord
    1. Consequences – inc demand on quads
      • inc JRF at knee & patellofemoral jt.
      • Dec limb stability
      • Dec step-length
      • E.g. CROUCH gait in cp
Rarely used as compensatory mechanism b/c of energy inefficiency.
  1. Swing phase
    1. Primary causes – hams spasticity/ contracture
    2. May be compensatory mechanism to allow toe clearance in intial swing or mid-swing when PF or dec hip flexion r present e.g. steppage gait
    3. Terminal swing- it allows fore-foot strike at IC for a pt with heel pain.
    4. Consequences- dec step-length
-impaired positioning of foot at IC

Characterized with dec step-length of c/l limb, crouch gait, steppage gait.
KNEE JOINT


Inadequate flexion/ Hyperextension


  1. Stance Phase
    1. Primary cause-quads spasticity/ contracture
    2. Hyperextension of the knee – called recurvatum gait may be a result of aggressive medial/lateral distal hams lengthening, e.g. IC cp.
    3. Secondary cause-inc in stance phase ankle PF, which may cause recurvatum.
    4. May reflect a compensatory deviation for knee/patellofemoral pain, weakness of quads-as in polio.
    5. Consequences- dec shock absorption ability
-dec forward progression of tibia & potential injury to posterior knee
structures
-sub-optimal positioning of limb for IC & LR


B) Swing Phase
  1. Primary cause-quads spasticity /contracture e.g. as in stiff knee gait.
  2. Secondary cause – hip flexor weakness,
-PF contracture
3. May occur as a compensatory mechanism for knee pain/quad weakness.
  1. Consequence-impaired foot clearance in initial & mid-swing
-pre-swing knee flexion is lost in PF contracture b/c earlier quads
-control is not terminated in time


  • Knee HE –commonly used to move body forward when tibia can’t advance sufficiently.
  • Induced by body momentum for knee extension stability in quads weakness

Excessive Ankle Dorsal Flexion-calcaneal gait

Excessive Ankle Dorsal Flexion-calcaneal gait


  1. Stance Phase
    1. Primary causes- weakness of PF
    2. Secondary causes- excessive knee flexion due to hams. Contracture/spasticity
-as a compensation for forefoot pain
-with an aim to shorten the step-length of opposite limb
    1. Consequences – in LR & mid-stance inc demand on quads.
-dec shock absorption demands of LR
- In terminal stance –heel rise is compromised
-Body wt will not advance to fore-foot due to
lack of tibial control
-pt is not prepared for effective terminal stance
-momentum for next step is lost


  1. Swing phase
    1. Excessive DF is unusual


Characterized by

  • Dec step-length of c/l limb
  • Stride –length is shortened
  • Dec limb stability
  • E.g. crouch gait in cp
  • Pts with weak quads walk with knee HE if they can.

Kinematic analysis - common gait deviations ANKLE JOINT

Kinematic analysis - common gait deviations


ANKLE JOINT


Excessive Ankle Plantar Flexion- clinically described as Equinnus gait , commonly seen in cp



A) Stance Phase
1. Primary causes-Plantar flexors spasticity, contracture
2. ubstitution for –weak quads.
Ankle/forefoot pain
3.Consequences-dimished shock absorption-by limiting knee flexion in LR
-dec. forward progression of tibia over ankle
B) Swing phase
1.Primary cause- weakness/impaired selective control of DF
-PF spasticity/contracture


2. Consequences- interferes with foot clearance, foot positioning for IC
-results in toe-drag at mid-swing
-danger of tripping- can be averted by inc knee & hip flexion during swing if
proprioception is intact


Characterized by moderate reduction in gait velocity, inability to run, MT pain( due to chronic overuse of soft tissues), flat-foot posture
Where toe clearance is achieved by * circumduction
*non stance hip hiking

*vaulting at mid stance

Kinematics Analysis of Gait

* is used to describe movement patterns without regard for the forces involved in producing movement.
* it involves description of movement of the body as a whole and\or segments in relation to one another during gait.
  • Qualitative KA-assessment of displacement ( primary variable assessed),
description of pattern of movement, deviation from normal body postures, joint angles at specific points in gait cycle.


  • Quantitative analysis- used to obtain information on spatial and temporal variables as well as motion patterns
Temporal – stance-time, single-limb support time, double-support time, swing time, sride duration, step duration, cadence, gait speed/velocity, acceleration
Spatial- stride length, step length, stride-width, toe-out angle, width of BOS


Major determinants of normal & pathological Gait.
Ist determinant - Pelvic Rotation- (energy cost is reduced vert displacement of cog is min.)
2nd determinant -Lateral Pelvic Tilt - pelvic drop in frontal plane-( energy saving, lower vert drop)
3rd determinant - Knee flexion in the stance phase -permits with velocities of % out at minimum up in energy
4th determinant & 5th determinant- Foot & Knee interaction at 1C, the foot id DF & Knee is extended fully, so that the extremity is at its maximum length & C.O.G has reached its lowest point of downward displacement.
6th determinant- lateral displacement of pelvis (rhythmic, smooth gait)


-The pathologic processes that affect gait usually compromise joint mobility & muscle activity by 3 general mechanisms—


* deformity- soft tissue contracture
* muscle dysfunction's- NM disorders


* pain- contributes to muscle dysfunction & deformity.

Saturday, August 6, 2016

Gait - pattern of walking

Hi Friends,
we are going to start a CME lectures on Pathological gates . We will also try to understand the science behind normal GAIT (walking pattern) and abnormal one. Understanding Gait
pattern is very important for healthcare professionals as this may also inter related to spinal problems sometimes.
Students can send their queries in comment box for more details.

Introduction

Human locomotion or gait may be described as a translatory progression of the body as a whole, produced by coordinated rotatory movements of the body segments.


Ralston- noted that human gait involved to take an individual from one point to another & minimal expenditure of energy.
Normal gait is rhythmic & is characterized by alternating propulsive & retropulsive motion of lower extremity.
In normal walking, a gait cycle commences when the heel of the reference extremity contact the supporting surface & ends when the heel of the same extremity contacts the ground again.


Gait cycle

Stance phase- it consists 60% of gait cycle
  • Initial contact
  • Loading response
  • Mid-stance
  • Terminal stance
  • Pre-swing


IC- beginning of 1st phase when heel contacts the contact surface
LR- position of the Ist double support period of the stance phase from IC, until the c/l extremity leaves the ground.
MSt- portion of the single limb support stance phase begins when c\l extremity leaves the ground, ends when the body is directly over the supporting limb.
TSt- last portion of the single limb support stance begins with heel rise, continues till c\l extremity contacts the ground.
PSn- portion of stance phase begins with 2nd double support period from IC of c\l extrenity to toe-off of the reference extremity.




Swing Phase-40% of the gait cycle


Initial swing Mid swing Terminal swing
Portion of swing from the point portion of the swing phase from portion of the
When the reference extremity max. Knee flexion of ref. extremity swing phase from
Leaves the ground to maximum to a tibial vertical position
Knee flexion of the same.
Tibial vertical to
Just prior to initial
contact


Pathological gait may be viewed as an attempt to preserve as low a level of energy consumption as possible - by exaggerations of the motions at unaffected levels.
M.Saunders et al


* In abnormal gaits, the heel may not be the first part to contact the ground.: the gait cycle may be considered to begin when some portion of the reference extremity contacts the ground & ends when that same portion contacts the ground again.


Analysis
* The rapid speed at which the motion takes place makes a spontaneous visual analysis of pathological gait difficult.


* { in one second, a highly complex, multi-joint, bipedal, neuro-musculo-skeletal locomotor system (proceeding at the rate of about 3 m/ hour) transverses a distance of about 5 feet.}


Types of analysis- ( 2 broad categories)
1. Kinetic analysis:
Is used to determine the forces involved in gait i.e. GRF, C.O.P., C.O.M, mechanical energy, moments of force, power, work , joint reaction forces, { GRF- the net vertical & shear/ horizontal forces acting below foot & supporting surface. (3-D)

C.O.P - point of application of the GRF vector that is located below the feet in bilateral stance.

C.O.M- weight of the body is said to be concentrated COM; at the level of S2

rest in next session..........

Sunday, July 31, 2016

Alice in Wonderland syndrome (AIWS)

Alice in Wonderland syndrome (AIWS), or micropsia:

Alice in Wonderland syndrome (AIWS), or micropsia is a disorienting neurological condition which affects human visual perception.

Alice in Wonderland syndrome (AIWS)

Symptoms:
1. Impaired visual perception
2. Disorientation
3. Tiny vision
4. Inability to interpret
5. Size nonrecognition patient perceive humans, parts of humans, animals, and inanimate objects as substantially smaller than in reality.

Patient suffering from Alice in Wonderland syndrome (AIWS) perceived appears far away or extremely close at the same time. For example, a cow may appear the size of a goat, or a normal car may look shrunk to toy. Because of this we also call this condition as  Lilliput sight or Lilliputian hallucinations, named after the small people in Jonathan Swift's Gulliver's Travels Tales.

The condition is in terms of perception only, the mechanics and kinetics of the eyes are not affected, only the brain's interpretation of information wrongly passed from the eyes leads to this funny condition.

Tuesday, July 26, 2016

THE GURU AND HIS DISCIPLE STORY


There was once a disciple of a Guru who went to his Guru and said, "Guruji, I want to live a spiritual life. I want to live in the service of God. I want to go beyond the binding chains of this
mundane, materialistic world. But, I feel that I am not quite ready. My desires for a family, for wealth and enjoyment are still too strong. Grant me some time to fulfill these wishes and then I will come to your holy feet."

So the Guru said, "No problem, my child. Go. Get married, have a family and earn wealth. In ten years I will come back for you. My blessings are with you."

With the blessings of his Guru, the man went out and quickly found a beautiful girl to marry. They had 3 beautiful children, and the man become financially successful.

After 10 years, there was a knock on the door of their home. The man's wife opened it to see a haggard-looking man standing on the doorstep. The man asked to see her husband. At first she started scolding the man, thinking that he was just there to beg for money. But, the husband realized that the person was his Guru so he lovingly invited him inside.

"I have come to take you away from this world of illusions now that you have fulfilled your desire of having a wife, family and earnings. Come with me, my son, let me show you the way to God."

But, the man looked at his Guru pitifully and he said, "Dear, Beloved, Guru. Yes, you are right. You have given me my 10 years ever so generously and with your blessings I have prospered. But, my children are very young and my wife is again with child. She would not be able to handle the burden of all of them alone. Allow me to stay another ten years until the children are old enough to care for themselves."

A true Guru will guide you to the path, show you the light and help when help is requested, but will never force a disciple – against the disciple's will - to follow any particular path. Thus, the man's Guru compassionately agreed, saying, "So be it, my son. Stay another 10 years until you feel that your mission is fulfilled."

Ten years later, the Guru returned to the home to find a large bull- dog out front guarding the house. Immediately he recognized his disciple in the dog and saw - with his divine vision - that the man had passed away several years prior but, due to his intense protectiveness over his family and wealth, he had reincarnated as a guard dog.

The Guru put his hand on the dog's head and said, "My child, now that you have regressed from a human to a dog due to your attachment to these worldly things, are you finally ready to come with me?"

The dog licked the hand of his Guru lovingly and said,"My beloved Guruji. You are right that it is my own attachment which has driven me to take birth as a dog, but you see my children have many enemies who are envious of their wealth and power. These enemies are very dangerous to my children and I must stay here to protect them. However, I am sure that within a few years everything will sort itself out and they will be fine. Give me just seven more years to protect them, then I am yours."

The Guru left and returned 7 years later.

This time, there was no dog out front and the home was filled with grandchildren running around. The Guru closed his eyes and saw with his divine vision that his disciple had taken birth in the form of a cobra, wedged into the wall near the family safe to guard the money.

He called the grandchildren of the house: "My children," he said. "In the wall to the right of your safe, there is a cobra curled up in a small nook. Go there and bring the cobra to me. Do not kill it. It will not harm you, I promise. But, just break its back with a stick and then bring it to me."

The children were incredulous, but went to the wall where the old man had directed them.
Incredibly they saw that just as the Guru had said a cobra was curled up in the wall. Following his orders, they broke the cobra's back and carried it outside to the Guru. The Guru thanked the
children, threw the cobra over his neck and left.

As he walked away carrying the cobra over his neck, the Guru spoke to the cobra, injured and aching, "My child, I am sorry for hurting you, but there was no other way. Twenty seven years and three births ago you left to taste the material world of sensual pleasures.

But the ways of Maya are so alluring and so subtle that they trap us instantly. You have wasted these lifetimes in the futile pursuit of material success and in attachment to people who also are only actors in the Cosmic Drama. My child, all here is Maya – Cosmic Illusion. It lures us into its trap, convincing us that it is real, permanent, everlasting and significant.

But, in reality, the only thing which is real is HIM, and the only true purpose of life is to get close to HIM. These attachments merely divert our attention and focus away from the true purpose of
life. I had no choice but to come to your rescue as I saw you sinking deeper and deeper into the deep clutches of Maya."!
Having said so, the Guru full of love and care carried the snake to his ashram to teach him the Truth, while the snake regretting his act of attachment to the world and not to his Guru or the Truth sunk in shame and realised what he had lost and had wasted all these years!!

SPIRITUAL COMMENTARY

So frequently in life we think, "Just one more year" then I will cut back on my luxuries and cut back on my time at the office.
"Just one more year" and I will dedicate more time to meditation and spiritual pursuits.

"Just one more year" and then I will go to India, sit at my Guru's feet and delve into the divine depths of spirituality.

"Just one more year" and then I will cut down on my sensual pleasures.". ...and on and on.

But, that "one more year" never comes.

Our intentions are good. We want to be more spiritual. We want to devote more time to spiritual pursuits. We want to spend less, need less and serve more. We want to be the master over our lust, anger and greed rather than vice versa.

But, the power of Maya is stronger than the power of our will. Thus, we continue to find excuses for why we must continue to work 50 or 60 hour work-weeks, why we still have no time for meditation, why we can't squeeze a visit to the holy places of India into our year's planning, and why we must continue to satiate our insatiable sensual urges.

The only way to break free from the veil of illusion that Maya wraps
around our minds is to surrender to God and beg Him to show us the true light.

The only way to break free is to make AND STICK TO concrete vows of how we are going to be better people next year.

Rather than saying "I will find time to meditate" we must say "I will not leave for work without sitting in meditation and I will not sleep at night without doing my nightly introspection. "

Rather than saying, "I will try to come to India and visit holy places whenever I can," we must say "I will take my vacation this year in India and nowhere else."

Rather than say, "I will try to cut back on my expenses so that my financial needs are less," we must say, "I will not buy another jacket or pair of shoes [or anything] until the ones that I have are
broken, torn or no longer fit me."

Rather than say, "I will try to overcome my anger, lust and greed," we must commit to having daily appointments with God in which we introspect on all the times we allowed ourselves to be overpowered by these emotions and we must pray for strength, DAILY, to be remain calm, peaceful and sattvic in our lives."

If we wait for the right time, that time will never come. The only time is NOW. May God bless us all with the clarity of vision to realize that the external world is Maya and with the strength, fortitude and dedication to remove the veil and attain the Divine Truth!!

Sunday, June 26, 2016

TREATMENT FOR CALCANEAL SPUR

TREATMENT FOR CALCANEAL SPUR

• Stretching exercises

•Shoe recommendations

•Taping or strapping to rest stressed muscles and tendons

•Shoe inserts or orthotic devices
• Physical therapy.  

 SURGICAL TECHNIQUES INCLUDE:

•Release of the plantar fascia

•Removal of a spur

Monday, May 30, 2016

CMEs or continue medical education


CMEs or continue medical education are the educational lectures which are more concerned with practical aspects of medical field.

CMEs

CMEs or continue medical education are the educational lectures which are more concerned with practical aspects of medical field.